Nitrous oxide for sedation during intravenous access in children

January 01, 0001

Nitrous oxide for sedation during intravenous access in children

These Swedish investigators conducted a double-blind, randomized controlled trial to determine whether treatment with midazolam or with nitrous oxide is more efficient in facilitating intravenous (IV) access in lean and obese children and adolescents. They included 60 obese children and adolescents and 30 growth-retarded children and adolescents, aged 5 to 18 years, with reported anxiety and/or difficulties with IV access. The patients were randomly assigned to receive midazolam (dose, 0.3 mg/kg; maximum dose, 15 mg), 50% nitrous oxide, or 10% nitrous oxide. All patients received lidocaine- prilocaine. Efficiency was measured as total procedure time. A successful procedure was defined as 2 attempts for 2 IV lines.

They found: "Treatment with 50% nitrous oxide was the most efficient with regard to total procedure time. An unfavorably long procedure time was observed after treatment with midazolam, especially in obese patients. An increased number of successful IV line procedures were obtained in the group of patients who received 50% nitrous oxide compared with the midazolam group and 10% nitrous oxide group. The patients' evaluations were significantly more positive for 50% nitrous oxide than for both midazolam and 10% nitrous oxide, whereas no such difference was observed between midazolam and 10% nitrous oxide."

The authors concluded: "Compared with treatment with midazolam, treatment with 50% nitrous oxide during IV line procedures results in a shorter total procedure time, improved rate of IV access, and a better experience for the child or adolescent. Only under rare circumstances should obese children or adolescents be treated with midazolam because of the long procedure time."

50% nitrous oxide worked best for sedation during IV access procedure in children reported to have prior difficulties with such procedures.

For the full abstract, click here.

Arch Pediatr Adolesc Med 165(9):785-791, September 2011 © 2011 to the American Medical Association
Efficient Intravenous Access Without Distress-A Double-blind Randomized Study of Midazolam and Nitrous Oxide in Children and Adolescents. Kerstin Ekbom, Sigridur Kalman, Jan Jakobsson, Claude Marcus. Correspondence to Ms. Ekbom: [email protected]

Category: A. General/Unspecified. Keywords: children, adolescents, intravenous access, sedation, midazolam, nitrous oxide, obesity, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 20 September 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.